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Age-guided therapy for suspected bacterial meningitis Ceftriaxone* appropriate for all outside of neonatal period (>3 months) Vancomycin for possible resistant S. pneumoniae Listeria possible at extremes of age add ampicillin if age less than 1-3 months or greater than 50 years

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Is encephalitis a possibility? Herpes simplex encephalitis What are probabilities? Is timing as important? Should further tests be run? What? Empiric acyclovir?

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Steroids? Are steroids useful or important in acute bacterial meningitis? Dexamethasone studies...

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LP options Fluoroscopy? Is it important now in this case? after all, broad antibiotic coverage... a) acceptable to defer LP until later time? b) go forward at all costs to get fluid? c) defer for moment; revisit later?